W7 - Prevention & Management of Aggressive Behaviour

Question 1

What is the assault cycle? (5)

Answer 1

1. Trigger
   - Restlessness, anxiety, anger
2. Escalation
   - escalating behaviour that shows loss of control
   - clenched fists, threatens, loss of ability to think clearly
3. Crisis
   - Loss of physical & emotional control
   - screaming
   - cannot communicate clearly
4. Recovery
   - Relaxed, returns to normal
   - Lowered voice, more rational communication
5. Post-crisis
   - Attempts to reconcile with others
   - Remorse, crying, quiet, withdrawn
   - might repress assaultive feelings

Question 2

What are the nursing management of aggressive patients? (5)

Answer 2

During triggering phase:
- Encourage pts to verbalise feelings & validate their feelings
- Use simple, clear, short sentences - tell them you are here to help, not hurt
- Let them be in control & make decisions
- Go to quiet area to decrease stimulation
- Ask them what you can do to help

Escalation phase:
- Nurse take control of the situation
- Give directions to client in calm & firm voice
- Time out
- Tell client that aggressive behaviour is not acceptable & you are there to help
- If unwilling to accept directions: 4-6 nurses get ready in client’s sight

Crisis phase:
- 4-6 trained staff to restrain client safely: 1 hold each limb, 1 protect head, 1 control torso

Recovery phase:
- Encourage client to talk abt the situation & triggers that caused aggression
- Explore alternatives to aggressive behaviour by asking what client/staff can do next time to avoid an aggressive episode

Post-crisis phase:
- Discuss behaviour in calm, rational manner
- Give feedback to client on how to regain control & expect that they will be able to handle things in a nonaggressive manner in the future

Question 3

What are behavioural risk factors for aggression? (5)

Answer 3

1. Poor impulse control
2. Escalating anger
3. Controlling, exploitive, manipulative interaction style
4. Antisocial & criminal acts
5. Say they intent to harm themselves

Question 4

What’s the crisis intervention? (4)

Answer 4

1. activate crisis alarm
2. wait for care team to arrive
3. maintain a safe milieu (safe, supportive, healing env for both pts & staff)
   - teach impulse control: count to 10, participate in regular, tough physical activity, remove yourself from the situation
4. use physical/chemical restraints